Facility Evaluation Report

Unannounced annual licensing visit made out to this facility on 07/27/2023 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility caregiver, Amy Glass, who was briefly interviewed. This LPA requested that the facility caregiver go ahead and contact the facility designated Administrator, Melinda Womble, to inform her that CCL was present at this time. The facility designated Administrator, Melinda Womble, arrived shortly thereafter to this facility. A brief interview was conducted with the facility designated Administrator at this time.

This facility is licensed to serve and accept up to 6 residents who are deemed to be ambulatory only. This facility is also vendorized to accept and retain Level 4F residents at this time.

Current census was 5 residents. It was learned that (4) of the residents were not present at this time since they attended their own day programs. There was only (1) resident present at the time of this visit.

Kitchen area was toured. Cabinets and drawers were reviewed. Drawers and cabinets housing cleaning supplies were observed to be locked and made inaccessible to the residents at this time.

Drawers containing knives and other cutlery were observed to be locked and made inaccessible to the residents at this time.

Food supply was reviewed for 2-day perishable and 7-day nonperishable food quantities at this time. Additional nonperishable food items were observed to be stored in the garage area along with additional refrigerator and freezer units.

Dining room, living area, and all other areas designated for resident use were observed to be maintained and observed to be in compliance at this time.

A tour of the resident bedrooms was conducted. Furniture and furnishings were observed to be present and maintained in compliance at this time.

A tour of the resident restrooms was conducted. Shower areas, toilets, and wash basins were reviewed and observed to be functional and in good repair at this time.

Hot water temperatures were taken and measured to make sure that they were within the allowed range of 105-120 degrees.

Medication for resident use, located in entry way cabinet, was reviewed. Policies and procedures for